Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri.
Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri.
JAMA Netw Open. 2023 Jun 1;6(6):e2320276. doi: 10.1001/jamanetworkopen.2023.20276.
Lower neighborhood and household socioeconomic status (SES) are associated with negative health outcomes and altered brain structure in children. It is unclear whether such findings extend to white matter and via what mechanisms.
To assess whether and how neighborhood and household SES are independently associated with children's white matter microstructure and examine whether obesity and cognitive performance (reflecting environmental cognitive and sensory stimulation) are plausible mediators.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used baseline data from participants in the Adolescent Brain Cognitive Development (ABCD) study. Data were collected at 21 US sites, and school-based recruitment was used to represent the US population. Children aged 9 to 11 years and their parents or caregivers completed assessments between October 1, 2016, and October 31, 2018. After exclusions, 8842 of 11 875 children in the ABCD study were included in the analyses. Data analysis was conducted from July 11 to December 19, 2022.
Neighborhood disadvantage was derived from area deprivation indices at participants' primary residence. Household SES factors were total income and highest parental educational attainment.
A restriction spectrum imaging (RSI) model was used to quantify restricted normalized directional (RND; reflecting oriented myelin organization) and restricted normalized isotropic (RNI; reflecting glial and neuronal cell bodies) diffusion in 31 major white matter tracts. The RSI measurements were scanner harmonized. Obesity was assessed through body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), age- and sex-adjusted BMI z scores, and waist circumference, and cognition was assessed through the National Institutes of Health Toolbox Cognition Battery. Analyses were adjusted for age, sex, pubertal development stage, intracranial volume, mean head motion, and twin or siblingship.
Among 8842 children, 4543 (51.4%) were boys, and the mean (SD) age was 9.9 (0.7) years. Linear mixed-effects models revealed that greater neighborhood disadvantage was associated with lower RSI-RND in the left superior longitudinal fasciculus (β = -0.055; 95% CI, -0.081 to -0.028) and forceps major (β = -0.040; 95% CI, -0.067 to -0.013). Lower parental educational attainment was associated with lower RSI-RND in the bilateral superior longitudinal fasciculus (eg, right hemisphere: β = 0.053; 95% CI, 0.025-0.080) and bilateral corticospinal or pyramidal tract (eg, right hemisphere: β = 0.042; 95% CI, 0.015-0.069). Structural equation models revealed that lower cognitive performance (eg, lower total cognition score and higher neighborhood disadvantage: β = -0.012; 95% CI, -0.016 to -0.009) and greater obesity (eg, higher BMI and higher neighborhood disadvantage: β = -0.004; 95% CI, -0.006 to -0.001) partially accounted for the associations between SES and RSI-RND. Lower household income was associated with higher RSI-RNI in most tracts (eg, right inferior longitudinal fasciculus: β = -0.042 [95% CI, -0.073 to -0.012]; right anterior thalamic radiations: β = -0.045 [95% CI, -0.075 to -0.014]), and greater neighborhood disadvantage had similar associations in primarily frontolimbic tracts (eg, right fornix: β = 0.046 [95% CI, 0.019-0.074]; right anterior thalamic radiations: β = 0.045 [95% CI, 0.018-0.072]). Lower parental educational attainment was associated with higher RSI-RNI in the forceps major (β = -0.048; 95% CI, -0.077 to -0.020). Greater obesity partially accounted for these SES associations with RSI-RNI (eg, higher BMI and higher neighborhood disadvantage: β = 0.015; 95% CI, 0.011-0.020). Findings were robust in sensitivity analyses and were corroborated using diffusion tensor imaging.
In this cross-sectional study, both neighborhood and household contexts were associated with white matter development in children, and findings suggested that obesity and cognitive performance were possible mediators in these associations. Future research on children's brain health may benefit from considering these factors from multiple socioeconomic perspectives.
重要性：较低的社区和家庭社会经济地位（SES）与儿童的负面健康结果和大脑结构改变有关。目前尚不清楚这些发现是否适用于白质，以及通过什么机制。
目的：评估邻里和家庭 SES 是否以及如何独立地与儿童的白质微观结构相关，并研究肥胖和认知表现（反映环境认知和感官刺激）是否是合理的中介因素。
设计、地点和参与者：这是一项横断面研究，使用了青少年大脑认知发展（ABCD）研究的基线数据。数据在 21 个美国地点收集，学校招募用于代表美国人口。9 至 11 岁的儿童及其父母或看护人在 2016 年 10 月 1 日至 2018 年 10 月 31 日期间完成了评估。排除后，ABCD 研究中的 11875 名儿童中有 8842 名被纳入分析。数据分析于 2022 年 7 月 11 日至 12 月 19 日进行。
暴露：社区劣势来自参与者主要居住地的区域剥夺指数。家庭 SES 因素是总收入和父母受教育程度最高。
主要结果和测量：使用受限各向异性成像（RSI）模型对白质中 31 个主要束的受限归一化定向（RND；反映有向髓鞘组织）和受限归一化各向同性（RNI；反映胶质和神经元细胞体）扩散进行量化。RSI 测量结果经过扫描仪协调。肥胖通过体重指数（BMI；体重以千克为单位除以身高以米为单位）、年龄和性别调整后的 BMI z 分数和腰围进行评估，认知通过国家卫生研究院工具包认知电池进行评估。分析调整了年龄、性别、青春期发育阶段、颅内体积、平均头部运动和双胞胎或兄弟姐妹关系。
结果：在 8842 名儿童中，4543 名（51.4%）是男孩，平均（SD）年龄为 9.9（0.7）岁。线性混合效应模型显示，较大的邻里劣势与左侧上纵束（β=−0.055；95%CI，−0.081 至−0.028）和大头状束（β=−0.040；95%CI，−0.067 至−0.013）的 RSI-RND 较低相关。父母受教育程度较低与双侧上纵束（例如右半球：β=0.053；95%CI，0.025 至 0.080）和双侧皮质脊髓束或锥体束（例如右半球：β=0.042；95%CI，0.015 至 0.069）的 RSI-RND 较低有关。结构方程模型显示，较低的认知表现（例如，总认知评分较低和邻里劣势较高：β=−0.012；95%CI，−0.016 至−0.009）和更高的肥胖（例如，BMI 较高和邻里劣势较高：β=−0.004；95%CI，−0.006 至−0.001）部分解释了 SES 与 RSI-RND 之间的关联。较低的家庭收入与大多数束的 RSI-RNI 较高相关（例如，右侧下纵束：β=−0.042 [95%CI，−0.073 至−0.012]；右侧前丘脑辐射：β=−0.045 [95%CI，−0.075 至−0.014]），较大的邻里劣势在主要额-边缘束中具有类似的关联（例如，右侧穹窿：β=0.046 [95%CI，0.019 至 0.074]；右侧前丘脑辐射：β=0.045 [95%CI，0.018 至 0.072]）。父母受教育程度较低与大头状束的 RSI-RNI 较高有关（β=−0.048；95%CI，−0.077 至−0.020）。肥胖在一定程度上解释了这些 SES 与 RSI-RNI 的关联（例如，BMI 较高和邻里劣势较高：β=0.015；95%CI，0.011 至 0.020）。在敏感性分析中，这些发现是稳健的，并且使用扩散张量成像得到了证实。
结论和相关性：在这项横断面研究中，邻里和家庭环境都与儿童的白质发育有关，研究结果表明，肥胖和认知表现可能是这些关联的中介因素。未来关于儿童大脑健康的研究可能受益于从多个社会经济角度考虑这些因素。
